Responding to Psychosis in Homeless Services (this presentation has been adapted from the Youth Mental Health First Aid program)
WHAT ARE PSYCHOTIC DISORDERS?
Psychosis is a mental disorder in which a person has lost some contact with reality.
Psychosis is characterized by delusions, hallucinations and thought disorder.
There may be severe disturbances in thinking, emotion and behaviour.
Psychosis severely disrupts a person’s life.
Relationships, work, study and self-care are difficult to initiate and/or maintain.
CHANGES IN EMOTION AND MOTIVATION
Blunted, flat or inappropriate emotion
Change in appetite
Reduced energy and motivation
COMMON SYMPTOMS WHEN A PSYCHOTIC DISORDER IS DEVELOPING
CHANGES IN THINKING AND PERCEPTION
Difficulties with concentration or attention
Sense of alteration of self, others or the outside world
(e.g.; feeling that self or others have changed or are
acting different in some way)
Unusual perceptual experiences (e.g. a reduction or
greater intensity of smell, sound or colour)
COMMON SYMPTOMS WHEN A PSYCHOTIC DISORDER IS DEVELOPING (cont’d)
CHANGES IN BEHAVIOUR
Social isolation or withdrawal
Reduced ability to carry out work and social roles
IMPORTANCE OF EARLY INTERVENTION FOR PSYCHOSIS
Some of the consequences of delayed treatment include the following:
Slower and less complete recovery
Poorer long-term functioning
Increased risk of depression and suicide
Slower psychological maturing
Slower uptake of adult responsibilities
Strain on relationships and loss of social support
Disruption of study and employment
Increased use of alcohol and drugs
Loss of self-esteem and confidence
Greater chance of problems with the law
MAIN PSYCHOTIC DISORDERS
OTHER PSYCHOTIC ILLNESSES
Psychotic depression: a severe depression can have psychotic features.
Schizoaffective disorder: has symptoms of both schizophrenia and bipolar disorder.
Drug induced psychosis: is a psychosis brought on by drug use. Drugs that can cause psychosis are cannabis, cocaine, ecstasy, amphetamines and magic mushrooms.
SYMPTOMS OF SCHIZOPHRENIA
Loss of drive
COMMON SYMPTOMS IN MANIA
Increased energy and overactivity
Need less sleep than usual
Rapid thinking and speech
Lack of inhibitions
Lack of insight
POSSIBLE CAUSES of PSYCHOTIC DISORDERS Psychosis is caused by a combination of factors including:
Genetic factors: Although psychosis is not directly inherited, those with it in the family are at greater risk of developing a psychotic illness
Biochemistry: It is believed that psychosis involves a chemical imbalance in the brain
Stress: It is recognised that stress can be a trigger for psychosis in vulnerable people
Other factors include seasonal changes, head injury, birth complications and drugs.
Step 1: Assess Risk of Harm or Suicide
Two factors that may increase the risk of suicide are:
Hearing voices which command the person to hurt themselves.
Having multiple episodes and feeling that they cannot continue to live with the illness.
Seek further training on suicide prevention if needed
Young people who are psychotic may be at risk of self-harm, or occasionally, of harming others. Both these risks need to be considered.
Step 1: Assess Risk of Harm or Suicide (cont)
A very small percentage of people with psychotic disorders may threaten violence.
Violence accompanying a mental illness is not common.
Violence is more common if alcohol or other drugs are involved.
If the person is not at risk, move onto Step 2.
WHAT TO DO IF A PSYCHOTIC PERSON APPEARS THREATENING
Do not get involved physically.
Call the police.
Try to create a calm, non-threatening atmosphere.
Try to get the person to sit down.
Do not try to reason with acute psychosis.
Express empathy for the person’s emotional distress.
Comply with reasonable requests.
8. Adopt a neutral stance and a safe position.
Step 2: Listen non-judgmentally
Listen without judging the person as weak.
Do not be critical of the person.
Don’t give glib advice.
Speak calmly, clearly and in short sentences
Do not argue with the person.
Accept the delusions and hallucinations are real for the person but
do not pretend they are real for you.
Do not try to humour the person.
Step 3: Provide reassurance and information
It may not be appropriate to provide information about psychosis, when the young person has become more lucid.
Try to help the young person realise that:
They have a real medical condition.
Psychosis is not a common illness, but is well
known and researched.
Psychosis is not a weakness or character defect.
Effective help and treatments are available.
Do not make promises you cannot keep.
Step 4: Encourage young person to get appropriate professional help
Mental health teams
Family and friends
WHAT TO DO IF THE YOUNG PERSON DOESN’T WANT HELP?
Discuss situation with local mental health crisis team.
Attend a mental health carers’ support group.
Make appointment with GP or mental health professional to talk about the problem.
Find out about involuntary treatment.
Help write an advance directive.
Step 5: Help the young person to use self-help strategies
Many young people with a psychotic disorder also
have depression &/or an anxiety disorder.
Therefore relaxation, meditation and exercise may be useful.
Support groups may be very helpful.
YOUTH HOUSING SERVICES
Police need to be contacted where there is a threat of violence
Don’t forget to maintain the person’s dignity and self determination within reason
Keep good records of strange behaviours
Engage with a youth health services or GP who can help with tracking symptoms and diagnosis
Use the medicare Better Access program to access allied health services
Undertake training in mental health
Develop relationships with your local Headspace or youth health centre if you have one locally.
Please note….. This presentation also included excerpts from the Andrew Denton, Enough Rope episode called Angels and Demons. These include a simulated experience of schizophrenia and feedback from young people about what helped with treatment and recovery. You can view these sections and most of this episode at the following web address. http://www.abc.net.au/tv/enoughrope/interactive/angelsanddemons/